Please fill out the form below as completely as possible so that we will have a solid understanding of your home purchasing needs. The information you provide will be kept confidential. * = Required Field * First Name: * Last Name: * Address: * City: *State: *Zip: *Country: *Email: *Phone: - - select Daytime Evening Anytime 2nd Phone: - - select Daytime Evening Anytime Have you ever purchased a home before? select Yes No In what time frame do you wish to purchase a home: select Immediately Within 1 month in 1-3 months in 3-6 months in 6 months to 1 year in 1 to 2 years In what city/area do you plan to purchase a home? The home I plan to purchase will be used as: select My principle residence A rental property Other Will you be moving because of a new job or job transfer? select Yes No If your move is a result of a job transfer, will you be receiving cost assistance or relocation benefits from your current or future employer? select Yes No Maybe N/A If you currently own a home... Will you need assistance with the sale of your current home? select Yes No Maybe N/A Do you have an agent that you are planning to use to sell your current home? select Yes No Maybe N/A Would you like a market analysis prepared for your current home? select Yes No Maybe N/A Will you need the equity from your current home to purchase another? select Yes No Maybe N/A Miscellaneous Information... What price range will you be looking in? select $75,000 - $99,900 $100,000 - $124,999 $125,000 - $149,999 $150,000 - $199,999 $200,000 - $249,999 $250,000 - $349,999 $350,000 - $449,999 Above $500,000 Unknown How much of your savings/equity will you be using towards your purchase? Have you been pre-qualified or pre-approved for a mortgage by a bank or lending institution? select Yes No Would you like to be contacted by a mortgage lender for information on pre-qualifying for a mortgage or obtaining a pre-approved home loan? select Yes No Do you have any specific criteria regarding the style, size, amenities, features, etc. that you will need or would like to have in regards to the home you plan to purchase? Please select all that apply... Style Ranch Bungalow Colonial Tri-level Quad-level No preference Exterior Brick Aluminum/Vinyl No preference Bedrooms (select minimum required) 2 Bedrooms 3 Bedrooms 4 Bedrooms Over 4 Bedrooms No preference Baths (select minimum required) 1 bath 1.5 baths 2 baths 2.5 baths No preference Garage (select minimum required) 1 Car 2 Car 2+ Car Attached No preference Basement Must have No preference Square Footage Preference 800-1,000 1,000-1,200 1,200-1,500 1,500-2,000 2,000-2,500 Over 2,500 No preference Additional information, comments, questions, etc... How you found Steve's web site... What web site, search engine, directory, or advertisement directed you to this web site?

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Steve Hatfield, Realtor^®
CENTURY 21 Curran & Christie
25636 Ford Road
Dearborn Heights, MI 48127
Office: (313) 274-7200
eMail:



Copyright © 1996 - Steve Hatfield
Any Reproduction or Redistribution Without Authorization is Strictly Prohibited

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